A Comprehensive Computed Tomographic Analysis of Pneumatization Pattern of Sphenoid Sinus and Their Association with Protrusion/Dehiscence of Vital Neurovascular Structure in a Pakistani Subgroup.

AIM: To determine the clinically significant association between pneumatization types of the sphenoid sinus (SS) and protrusion/ dehiscence of the optic nerve (ON) and the internal carotid artery (ICA). MATERIAL AND METHODS: This prospective cross-sectional study was conducted between November 2020 and April 2021 at the Dow Institute of Radiology, Dow University of Health Sciences, Karachi. This study examined 300 computed tomography (CT) PNS patients aged 18-60 years. The forms of SS pneumatization, extent of pneumatization to the greater wing (GW), anterior clinoid process (ACP), and pterygoid process (PP), as well as the protrusion/dehiscence of the ON and ICA were examined. A statistical relationship was identified between pneumatization type and protrusion/dehiscence of the ON and ICA. RESULTS: The study included 171 men and 129 women with an average age of 39.28 ± 10.9 years. The most commonly encountered pneumatization type was postsellar (63.3%), followed by sellar (27.3%), presellar (8.7%), and conchal (0.75%). The most frequent extended pneumatization was observed up to PP (44%), followed by ACP (31.33%), and GW (16.67%). The rate of dehiscence of the ON and ICA was less than that of protrusion of the same structures. The association between postsellar and sellar pneumatization types and protrusion of the ON and ICA was statistically significant (p < 0.001), with the postsellar type showing more protrusions of the ON and ICA than the sellar type. CONCLUSION: The pneumatization type of SS has a significant impact on the protrusion/dehiscence of adjacent vital neurovascular structures and should be mentioned in CT reports to alert surgeons for any disastrous intraoperative complications and outcomes.

Anatomical variations of human sphenoid sinus in terms of volume and septation pattern in a subset of Pakistani population using computed tomographic images.

OBJECTIVE: To compare the sphenoid volume between the genders and to analyse variations in septal insertions on bony wall of optic nerve and internal carotid artery. METHODS: The prospective study was conducted from October 2020 to February 2021 at the Radiology Department of Dow University of Health Sciences, Karachi, and comprised paranasal sinus patients of either gender aged 20-60 without any bony deformity of sphenoid sinus who were analysed for sphenoid volume, number of septa and variable septal insertions using computed tomography of paranasal sinus. On the basis of septal insertions, the scans were categorised into Group 1 with no risky septal insertion, Group 2 with septal insertion on bony wall of optic nerve, Group 3 with septal insertion of internal carotid artery, and Group 4 with septal insertion on both optic nerve and internal carotid artery. Differences in sphenoid volume were analysed between males and females and among the four groups. Data was analysed using Graph Pad Prism 9. RESULTS: Of the 300 patients, 171(57%) were males and 129(43%) were females. The overall mean age was 39.28±10.9 years. Multiple septa were found in 208(69.3%) of the sinuses. There were 129(43.7%) patients in Group 1, 34(11.3%) in Group 2, 119(39%) in Group 3 and 18(6%) in Group 4. Significant difference was found between volume and gender as well as among the four groups (p<0.001). CONCLUSIONS: The sphenoid volume between the genders and the variations in septal insertions on bony wall of optic nerve and internal carotid artery were significantly different.